ABOVE-KNEE FEMOROPOPLITEAL BYPASS GRAFTS AND THE CONSEQUENCES OF GRAFT FAILURE

In all, 290 femoral to above-knee popliteal artery bypasses were perfo rmed between january 1983 and September 1991. PTFE grafts were used in 113 cases (39%) and vein grafts in 177 (61%) (reversed in 146 cases a nd in situ in 31). Patients were followed up for a median time of 20 m onths. The 2-, 4- and 6-year patency rates for vein and PTFE grafts we re 70%, 62% and 57%, respectively, compared with 58%, 46% and 41% (no statistical difference in survival curves, P=0.2). The 2-, 4- and 6-ye ar limb salvage rates were 82%, 78% and 62% compared with 75%, 64% and 58% (no statistical difference in survival curves, P = 0.6). A total of ''grafts occluded during follow-up (45 PTFE and 54 vein grafts). Ma jor amputation was required in 63 limbs; below-knee in 37 limbs (59%), and above-knee in 26 limbs (41%). There was no statistical difference in the amputation level with respect to the graft type. Final healing at the below-knee level was achieved in 23 of 35 (66%) failed vein gr afts and in 14 of 28 (50%) failed PTFE grafts.